Tag Archives: lasers

June 26th, 1990. That is the day that I hung my “shingle” in La Jolla and I saw my first patient. At the time, it was just myself and one incredible assistant helping me. The practice grew quickly and my little 800 square foot practice quickly doubled in size. That charming old building, which was home to a handful of long-time medical professionals, is now long gone, making room for newer condos.
Relocation to our current space proved to be a great move, enabling us to propel our small practice to a much more modern and efficient office.Dentistry has changed tremendously over the years as well. It was not long after opening our doors that we stopped offering silver mercury fillings as on option. There was too much controversy over the potential toxicity for ourselves and our patients. White fillings were, and still are, performing beautifully. The techniques for esthetic veneers, bonding, and bleaching were evolving rapidly and we were able to provide spectacular smile makeovers for many patients. Cosmetic dentistry changed both the expectations of our patients as well as everyone in the dental profession. Cosmetic dentists realized that all restorations from the simplest to the most sophisticated needed to be not only detailed in their accuracy and reliable, but also completely natural looking.
As dental implant designs improved, I saw the opportunity to be able to provide patients with solutions to the very challenging problem of replacing missing teeth with something strong, reliable and natural looking without the unnecessary preparation of other teeth. Bridges, both fixed and removable, were unattractive, not reliable enough, and were damaging to nearby teeth in the mouth. I am convinced that implant dentistry has been the most important advancement in the field of dentistry since the introduction of local anesthetics.
Over the years we have also seen many changes that improved the experience and safety for our patients. Digital x-rays replaced film based imaging. They are extremely detailed and provide instant results with a small fraction of the radiation. 3D imaging has enabled us to understand anatomy and pathology to a much greater level, creating better diagnosis and safer implant planning. Invisalign has helped countless adults straighten their teeth without embarrassing metal hardware. Lasers have been a great adjunct in managing gum tissue health. Simple sedation solutions have made helping many people with complex needs or anxieties much more comfortable. The list goes on and on.
After 25 years, I can truly say that dentistry continues to get more and more interesting. Now, along with my partner, Dr. Olson, we are planning another expansion of our office, in an effort to reach more people, offer more services and provide an even better experience. The future is as exciting as ever. I am extraordinarily grateful to La Jolla, our wonderful team, and all of our patients for their years of support and friendship.

Having your teeth fixed with dental implants in just one day….what a great idea! Even a better marketing angle. I’ve been asked so many times why dental implants take time when they keep hearing and seeing ads for immediate teeth that I know how well the marketing works.
To be perfectly fair, the “teeth in a day” protocol does work and many patients have gone through the process successfully. However, there are several caveats that must be considered.

First of all, the “teeth” are typically denture teeth which are fixed to a series of 4 to 6 implants in a row. All of the teeth in the dental arch need to be missing or removed for this to work. The implants arranged around the curvature of the arch is what allows for the “loading” of the immediate restoration. The idea of saving any teeth in the span is not possible. In addition to removing all of the teeth, several millimeters of bone and gum tissues need to be removed to create “restorative” space.

Secondly, the bone around the teeth needs to be healthy and free of infection. Placing implants into infected areas invites a risk of implant failure. Now, some of us are already scratching our heads wondering why would anyone want to remove perfectly good teeth that are not infected.

Once again to be fair, I am a dentist and have been placing and restoring dental implants for the past fifteen years. I believe that dental implantology is one of the greatest advances in dentistry of our time. That being said, I think there is nothing better than real teeth. Saving whatever we can, within practical considerations, is our first goal. It is true that dentures are awful! Food tastes and feels foreign, speech is difficult and the feeling of physical decline is oppressive. A full arch of implants holding on to a dental bridge is a bit better. Natural teeth, even a few in the arch, if that’s all that is feasible, is the best. One reason is that teeth have ligaments that hold them into the bone. Within this ligament space lies proprioceptive nerve endings. Unlike the sensation of hot and cold, these nerves send signals to the brain regarding pressure. It is part of how we interpret what food feels like. They help us determine how hard we need to bite when we are eating. Does a hot dog feel any different a good fillet? You bet it does. Implants offer absolutely no proprioceptive feedback.

Some people have not had much luck in taking care of their natural teeth. Implants may seem like a good way to escape from the hassle. Actually, they still need attention. Each implant needs to be cleaned around the tissue where it emerges, just like teeth. When there is a bridge or denture permanently attached to them, care and time needs to be taken to get underneath and do a thorough job. Loosing a dental implant under a complicated bridge can be an expensive complication.

Dr Olson and I believe in the proper and timely replacement of hopeless teeth to maintain proper force and load distribution within the arches. We also believe in the preservation of bone and healthy teeth wherever and whenever possible. Finally, we believe in creating restorations on dental implants that look, feel and function like natural teeth in keeping with our years cosmetic dental practice.

Look to our future blogs where we will be discussing the pros and cons of immediate placement and restoration of implants for single tooth considerations.

We all are familiar with the song we learned in childhood about how all the parts of the body are connected. The familiar lyrics and melodies of the skeleton dance song, “the knee bone is connected to the thigh bone and the thigh bone is connected to the hip bone”, make us realize early on that our bodies are one complicated and interconnected system. Today, we understand that the relations of the body’s parts and systems are intimately connected, and, operating as a spectacular symphony so complex that even the most educated scientists and doctors are in awe of their wonder.

Our oral health and overall health are also intimately related and connected. For many years, research has shown that periodontal disease can adversely affect and further complicate many systemic diseases such as diabetes, cardiovascular disease, respiratory diseases, and has even been linked to adverse pregnancy outcomes. We also know that uncontrolled systemic diseases can negatively affect the oral environment.

Millions of Americans show signs of periodontal disease, which is a chronic bacterial infection in the tissues surrounding the teeth that leads to gum inflammation and eventual bone loss. As periodontal disease progresses, bacterial enzymes break down gum tissue, and, as a result, the bacteria enters the body’s circulatory system. This oral bacteria can worsen pre-existing medical conditions and disease processes.

The relationship between periodontal disease and diabetes is a great concern for patients, as medical doctors and dentists alike understand the interplay that each has with the other. In general, diabetes can lower your resistance to infection and slow the body’s healing process. Diabetes, when not controlled, has a negative effect on gum health. Patients with inadequate blood sugar control seem to develop periodontal disease more often and more severely than those who have good control of their diabetes. In addition, periodontal disease has been shown to exacerbate a patients diabetic symptoms by creating a situation in which blood glucose levels are more difficult to maintain. This can be a vicious cycle, which in turn effects every other organ that is at risk in diabetics such as the heart, eyes, skin, lungs, nerves, kidneys and so on.

In addition to affecting diabetes, oral bacteria can play a role in cardiovascular disease by causing inflammation throughout the body and in arteries. This inflammation can contribute to the formation of atherosclerotic plaque, thus increasing the likelihood of heart attack and stroke.

Changes in hormone levels during pregnancy can increase gum tissue inflammation. Left uncontrolled, this pregnancy induced gingivitis can lead to periodontal disease, putting mothers at greater risk of having pre-term births and low birth weight babies. The theory is that toxins released by oral bacteria can reach the placenta and interfere with the development and growth of the fetus.

All evidence points to the fact that keeping our mouths as clean and as free of harmful bacteria as possible can reap huge benefits that extend far beyond our mouths. We know now that a little prevention goes a long way….not just in preventing cavities and gum issues, but by potentially avoiding much more serious health conditions in the future.

Be proactive! Always brush, floss, and make sure you are diligent about your routine dental check-ups and cleanings.

Over the years we have had the good fortune of helping so many wonderful people improve their smiles, replace missing teeth, and catch up on years of deferred maintenance. We are privileged to be in a very rewarding and purposeful career. What we also recognize about our profession is that many people cannot bring themselves to take care of their teeth due to fear of the “The Dentist” or concerns about time and money. That fear of the dentist is almost always rooted in a very real past experience that led to these feelings. We understand that the resulting anxieties are a natural defense that have been programmed and etched into those patient’s psyche.

Sedation Dentistry has allowed so many people to overcome their anxieties in a very safe and convenient manner. Patients are either asleep or totally relaxed during the entire visit. Almost everyone, when later asked about their experience with their dental visit, reports that it was very easy and comfortable, or they don’t remember the appointment at all.

For those patients that are tremendously busy, our approach is to try to schedule most or all of their needs in one appointment. Today, most of us don’t have time to schedule around multiple dental visits, especially when catching up on years of neglect. One or two longer visits are easier to schedule in our lives, and, with sedation, the longer visit is easy and comfortable. Just set the time aside, wake up a little while later, and voila, it’s done. By the way, discomfort afterwards is rarely a problem!

As for concerns over time and money, we all know how busy our lives get. Between our careers and family, sometimes our free time is squeezed out. There are so many activities and responsibilities, and, every year it just gets busier and busier. Who has time to go to the dentist? Unfortunately we are not immune to dental problems. We were not made with a maintenance free body or mouth, and, neglect of our mouths always catches up with us.

Let us stop finding reasons to put off taking care of our selves another day, week or year. We know the solutions to our dental needs NEVER get simpler if we wait!

As for money, certainly we know that fine quality dentistry and attentive care is expensive. It never gets cheaper with waiting. Maintenance is always less costly than neglect in the long run. The benefits of doing something well last much longer than the money saved doing it poorly.

A smile is the first thing you might notice about your Valentine. So what is it that makes a smile attractive?

“It has been proven that men and women are more attractive to the opposite sex when they have a genuine smile,” said Dr. Ashley Olson of D’Angelo Olson La Jolla Dentistry. “Your eyes and spirit are drawn to someone who is smiling because a smile radiates positive energy that makes others feel good. When a person smiles, they appear warm and friendly and are much more approachable. In addition, a beautiful smile can make you appear more intelligent, successful and interesting.”

Olson said a smile that shows a person’s teeth is more inviting to the person receiving the smile. “Teeth not only indicate good health, but they are also the focal point of a smile,” explained Olson. “The amount of upper and lower teeth that show in a smile is a key factor. Tooth shape is also a very important element. Rounded edges can make smiles look more feminine, while straight edges create a more masculine look. In our office, we evaluate how many teeth you display when you smile and how your lips will help set the stage for a terrific smile.”

And when that perfect smile is present, the perfect kiss may not be far behind. “Having confidence that our teeth and gums are healthy and our breath is fresh is an important part of the formula of attraction,” Olson said. “If a person is self- conscious about how their smile looks or how their breath smells, they may be less likely to be emotionally present in an intimate moment. Any sense of hesitation from a partner kills the mood. The best thing you can do to ensure you have a kissable smile is make sure you visit a dentist for routine cleanings and exams and also do your part at home by brushing and flossing daily.

“Kissing is absolutely healthy as it releases hormones like serotonin, dopamine and oxytocin that elevates your mood and can relax, restore, and revitalize you — similar to the benefits you get from exercising. Kissing also reduces stress by lowering cortisol levels (stress hormones).”

Olson, along with Dr. Joseph D’Angelo at the La Jolla office, can help bring about a person’s smile and confidence in just a handful of office visits.

“In our office, we will address your concerns and do our part in helping you feel confident and beautiful when you smile,” said Olson. “Whether you want a whiter smile,straighter teeth, or an improved shape of your teeth, we can help. When it comes to designing your new smile, we seek to create harmony and symmetry with your facial features. There is an underlying scientific and mathematical basis of beauty that we follow called ‘golden proportions.’ We aim to create a smile that fits to the overall proportions of the face and blends in gracefully.”

After Valentine’s Day, take that smile into daily life – it won’t let you down.

“An attractive and inviting smile reflects health, youth, and vitality, and can make a tremendous difference in your personal life. The next time you are about to ask someone out or are on a date, smile,” Olson suggested. “It’s contagious. You’ll feel great and you’ll share your happiness with others around you.”

An article presented this week by MSN news shared the results of a study by researchers which indicated a potential to regrow teeth in the future. Although, the reality of regenerating entire functioning teeth may be many years away or entirely impossible, the implications for our profession and our patients is quite real. The potential benefits with lasers in dentistry are very real and very current.

In the study, researchers stimulated tooth pulp tissues with a low power laser similar to what is used today to help gum tissues heal in the treatment of periodontal disease. They were able to show that the lasers stimulated the cells of the tooth pulp chamber to generate dentin. Dentin is the material that makes up the majority of the tooth structure.

A tooth has enamel, the hard outer covering protecting the surface, dentin that provides the structural integrity, cementum that lines the root surface, and the pulp chamber that provides nourishment, directs tooth development and provides sensation. Throughout adulthood, even after a tooth is fully developed, the pulp tissues slowly and continually create dentin. This is referred to as secondary dentin.

In this study the lasers apparently stimulated an increased production of dentin by cells that typically reside in the pulp tissues, possibly through increased normal activity, or, through helping cells differentiate into dentin producing cells.

One potential implication for all of us trying to manage dental disease is the concept of helping to prevent the need for a root canal when a tooth has decay that is very close to the pulp chamber. If the rate of dentin formation can be increased we may be able to help protect the pulp chamber. It also may help the the pulp chamber heal from a bacterial insult. Typically, if bacteria gets into the pulp camber the tooth will eventually need root canal therapy or need to be extracted if untreated.

Another possible benefit from laser therapy may be the treatment of sensitive teeth. If we can help insulate the nerve of a tooth by the formation of dentin underlying the sensitive area of the tooth or exposed root surface, relief for many patients may not be far off.

The good news is that this study may provide solid evidence that lasers have an effect on cells that results in a positive increase in activity that benefits healing.

Don’t hold your breath in anticipation that dentists may someday be able to grow new teeth. We are exited, however, about the current implications for management of gum disease through adjunctive laser therapy and the potential near future management of tooth disease. It is important to realize that management of dental health needs be ongoing with timely and prudent treatment of disease.